Enlarged Spleen: Symptoms, Causes & Treatment

An enlarged spleen, also referred to as splenomegaly, is characterized by an increase in spleen size. It can occur with viral infections like mononucleosis, liver disease like cirrhosis, changes to lymphatic organs or cancer. It causes symptoms like upper left abdominal pain and feeling full even with decreased food intake. 

A spleen is an organ found in the upper left quadrant of the abdomen, right behind the stomach and below the diaphragm. Its function is to store and produce white blood cell, to monitor for immune changes and to destroy damaged white blood cells. 

An enlarged spleen is diagnosed by a doctor or hematologist, and treatment will vary depending on the underlying cause. Prompt treatment will help to prevent further complications like infection or anemia. In more serious cases, surgical removal of the spleen may be advised. 

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Main symptoms 

An enlarged spleen will generally not present with any symptoms and, in most cases, is only found during testing.

However, the larger the spleen becomes, the more likely symptoms will occur. Some common symptoms are:

  • Pain or discomfort in the upper left quadrant of the abdomen. This pain can radiate to the left shoulder. 
  • Feeling full, even with decreased or no food intake 
  • Loss of appetite
  • Abdominal bloating 
  • Bleeding or red/brown skin patches 
  • Shortness of breath or difficulty breathing
  • Excessive fatigue 
  • Weight loss
  • Fever 
  • Chills 
  • General malaise 

You should especially seek medical attention when you feel right upper abdominal pain that is intense and is accompanied by other symptoms like confusion or dizziness, as this may indicate a ruptured spleen. This condition can cause hemorrhaging and can be life-threatening. 

It is important to see your doctor if you experience any of the above symptoms so that treatment can be initiated promptly. Learn more about what can cause spleen pain and how this pain can be treated.

How it is diagnosed

The diagnosis for an enlarged spleen is confirmed by a doctor through a physical exam and testing. The doctor will palpate the upper abdomen to assess for any swelling, and order bloodwork like a complete blood count, liver function tests, lipase levels and other rheumatological testing.  

Other exams that doctor may order can include an ultrasound, MRI or CT to verify the size of the spleen as well as the blood flow within the organ. The doctor can also order a bone marrow biopsy to diagnose or rule out a cause for the enlarged spleen. 

Causes of enlarged spleen 

Some causes of an enlarged spleen include: 

  • Infections like mononucleosis, malaria, bacterial endocarditis, tuberculosis, HIV or histiocytosis 
  • Autoimmune disease, like rheumatoid arthritis or lupus 
  • Spleen cancer or a blood cancer like leukemia or Hodgkin's lymphoma 
  • Heart problems, like congestive heart failure 
  • Liver disease, like cirrhosis or hepatitis
  • Metabolic disease, like Gaucher disease or Niemann-Pick disease 
  • Idiopathic thrombocytopenic purpura
  • Hemolytic anemia
  • Autoimmune neutropenia
  • Spleen injury 
  • Portal vein thrombosis in the liver 
  • Felty syndrome 

In addition, an enlarged spleen can also be associated with conditions like sarcoidosis, amyloidosis, hemangiomas, or metastatic cancers, as well as splenic cysts or abscesses. 

How it is treated 

Treatment of an enlarged spleen is monitored by a family doctor or hematologist. Treatment goals are aimed at treating the underlying cause and preventing further complications. The doctor may prescribe antibiotics to treat infections, transfusions to treat anemia, or chemotherapy to treat cancer, for example. 

In more serious cases, when the cause of an enlarged spleen cannot be identified or treated, or if the patient presents with complications, the doctor may opt to surgically remove the spleen. This procedure, known as a splenectomy, is generally completed laparoscopically, and recovery is typically quick. 

Possible complications

Complications associated with an untreated enlarged spleen include frequent infections (due to the reduced levels of red blood cells, white blood cells, and platelets), anemia and bleeding. 

In addition, the spleen can actually rupture, leading to hemorrhage and putting the patient in a life-threatening situation.